Defining Recovery, pt 2
By Tom Horvath, PhD
For many individuals, particularly those in 12-step groups, recovery means abstinence (and maybe not much else). I am “in recovery” if I am abstaining. However, there are also other important aspects of the process of change. Several national organizations have devoted substantial effort to defining recovery more broadly. The following definitions are available on the internet:
Faces and Voices of Recovery (undated): Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life.
SAMHSA (2005): Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life.
Betty Ford Institute Consensus Panel (2007): Recovery is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.
SAMHSA (2014): A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
NIDA (2017): Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential.
NIAAA (2022): Recovery is a process through which an individual pursues both remission from alcohol use disorder (AUD) and cessation from heavy drinking
Defining Recovery: Fully Incorporating a Harm Reduction Perspective
Some of these definitions have moved beyond abstinence as a requirement, but all appear to require that someone be in the action or maintenance stage of change (vs. pre-contemplation, contemplation, or preparation stages). For someone who has chosen to abstain (or is attempting to abstain) from “all” substances (not including nicotine, caffeine, or overeating), these definitions may feel suitable. Fortunately, these definitions also point to activities beyond abstinence, for those looking for further growth.
In terms of defining recovery, the existing definitions might not suit someone who is moderating alcohol consumption (after previously drinking excessively), using buprenorphine to prevent fentanyl use, using only clean needles by frequenting a needle exchange, or thinking about reducing gambling to a specific amount of loss each month (but not yet done so). If we are fully to transition to a harm reduction (or progress-oriented) approach for addictive problems (a transition we appear to be engaged in), we need a new definition of recovery. The existing definitions appear to recognize someone as “in recovery” only when they reach a certain level of success.
A Proposed Definition of Recovery
Recent research (What is “Recovery?” posted here on 11/2/23) suggests that most individuals who have made significant progress with an addictive problem view themselves as having focused on and (to some degree) accomplished:
- A process of growth or development
- Being honest with myself
- Taking responsibility for the things I can change
- Reacting to life’s ups and downs in a more balanced way than I used to
- Being able to enjoy life without drinking or using drugs like I used to
- Handling negative feelings without using drugs or drinking like I used to
- Abstinence (from alcohol, drugs, and/or RX drug abuse) and/or non-problematic alcohol/drug use
- Living a life that contributes to society, to your family, or to your betterment
[For a one-page self-survey based on these ideas, see the bottom of this blog]
The 11/2/23 blog pointed out the value of having these eight components as a checklist.
These eight ideas are a worthwhile audit for anyone addressing addictive problems. Treatment could orient itself around these components as goals, rather than being overly focused on reducing or eliminating substance use. Focusing on these other components may be an indirect but faster method for achieving non-problematic use or abstinence. When individuals with a history of substance problems talk about their process of change, they may appreciate being able to focus more on these aspects, rather than simply saying “well, I quit drinking.”
Today’s blog proposes a shorter definition of recovery. This approach to defining recovery includes a summary of these eight components, and adopts a harm reduction perspective:
Recovery is the process of identifying and addressing addictive problems, for a better life.
This proposed definition views the recovery process as beginning when someone enters the contemplation stage of change (rather than requiring the action or maintenance stage). In the contemplation stage we consider what addictive problems we might have, and how we might address them. Even this lowest level of change (thinking but not yet changing) can count as a level of recovery. The stages of the recovery process are the stages of change: contemplation, preparation, action, and maintenance.
To improve the chances that others understand that a revised definition of recovery is being used, we could refer to someone as being in the recovery process (at the contemplation, preparation, action, or maintenance stage). We might also need to recognize that someone might progress through these stages multiple times for “the same” substance or activity, and possibly be in multiple stages simultaneously. For instance, a drinker might be maintaining the change from drinking liquor to drinking beer and wine only, in the action phase for drinking only at social events, preparing to drink only 1-2 times per week, and contemplating abstaining. An opiate user might be maintaining using clean needles only, in the action phase for testing all substances before using them, preparing for not using other substances simultaneously with opiates, and contemplating a prescription for buprenorphine.
This proposed definition recognizes and includes the many individuals who are making progress (hopefully eventually accomplishing major change), even though they have not accomplished it (and may never). It also recognizes that many individuals who have achieved abstinence from their immediately compelling problem may now be ready to address nicotine, caffeine, overeating, or the myriad other components of living a better life. Even many 12-step members recognize that there is work after abstinence. For instance, an individual who is abstaining may be described as a “dry drunk” or “not in real recovery” because of the psychological growth that still needs to be accomplished. There is no endpoint to recovery, only the ongoing opportunity to live an even better life.
If we are using a harm reduction approach, then for consistency we should modify our definition of recovery to accommodate someone exhibiting “any positive change.”
**
How well am I addressing my addictive problems?
(Keep this form for yourself, and use it to assess your progress)
1=not at all or almost not at all
3=halfway there
5=entirely or nearly so
How well am I:
Engaging in personal growth and development
1 2 3 4 5
Being honest with myself
1 2 3 4 5
Taking responsibility for the things I can change
1 2 3 4 5
Reacting to life’s ups and downs in a more balanced way than I used to
1 2 3 4 5
Being able to enjoy life without relying on my addictive behavior like I used to
1 2 3 4 5
Handling negative feelings without relying on my addictive behavior like I used to
1 2 3 4 5
Engaging in non-problematic use/involvement, or abstaining
1 2 3 4 5
Living a life that contributes to society, to my family, and/or to my betterment
1 2 3 4 5
Based on a survey of over 9,000 individuals who were addressing a wide range of addictive problems by a wide range of methods. These aspects of change (from a list of 35 options) were endorsed by a very high percentage of individuals. You can consider this list as a consultation from your peers, about what to pay attention to and accomplish when it comes to defining recovery. Not every item will apply to every individual. You may wish to add items of your own.
Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From
the What is Recovery? Study. Zemore, SE, Ziemer, KL, Gilbert, PA, Karno, MP, & Kaskutas, LA. Substance Abuse: Research and Treatment, 17: 1–12. DOI: 10.1177/11782218231199372